Ophthalmology and Optometry Coding Alert

Question: When can we use the new cataract surgery code?

Maine Subscriber

Answer: Ophthalmologists and coders, drawn to the high reimbursement of the new cataract surgery code, 66982 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, endocapsular rings, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage), should pay attention to CPTs attempts to circumscribe this code. Overuse of the new code could lead to a reduction of the high value.

Code 66982 was created for complex cases of removal and lens insertion. For complex adult cases, many patients have weak lens support structures (such as small pupil, subluxated lens or pseudoexfoliation) due to a disease or injury (trauma, glaucoma, uveitis, Marfan syndrome, for example).

Pediatric cataract surgery is complex because, as CPT Assistant notes, the anterior capsule tears with great difficulty and the context is difficult to remove from the eye. A primary posterior capsularotomy or capsulorrhexis is necessary, which makes the insertion of the intraocular lens more difficult. And pediatric patients require more postoperative visits.

Iris retractors are necessary for many glaucoma patients with cataract surgery, and there must be additional incisions if a pupil is small or wont dilate. The existing code, 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]), doesnt cover the additional work of the incisions or any subsequent suturing to reconstruct the pupil after the cataract is removed.